PARA Weekly Update for Users Grayscale Version 3-21-2018

Date

PARA WEEKLY CODING FOR HPV SCREENING

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 March 21, 2018

HFMA Northern California

Com e See Us! March

NEWS FOR HEALTHCARE DECISION MAKERS26-27 IN THIS ISSUE QUESTIONS & ANSWERS - Travel Allowance - Home Based Telemonitoring - Nursing Unit Support Of Radiology - Place Of Service Radiology Reads - HBIG B Vaccine - Medicare Beneficiary Frequency Of Leave, Part A Skilled Nursing Facility OPPS & HCPCS UPDATE APRIL 1, 2018 2018 CODING COMPUTED RADIOGRAPHY

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The number of new or revised Med Learn (MLN Matters) articles released this week. All new and previous Med Learn articles can be viewed under the type "Med Learn", in the Advisor tab of the PARA Dat a Edit or . Click here.

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BILLABLE SUPPLIES FOR CAHS NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS

PARA COMPANY NEWS ABOUT PARA SERVICES CONTACT US

The number of new or revised Transmittals released this week. All new and previous Transmittals can be viewed under the type "Transmittals" in the Advisor tab of the PARA Dat a Edit or . Click here.

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FAST LINKS: Click on the link for special areas of interest: Page

Administration: Pages 1-40 HIM/Coding Staff: Pages 1-40 Providers: Pages 3,4,9,32,35 Laboratory Services: Pages 3,21,26 Imaging Services: Pages 7,8,16

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Home Health Services: Page 4 Skilled Nursing Facilities: Pages 10,22 PDE Users: Pages 12-15,18-19 Critical Access Hospitals: Page 17 Finance Depts: Pages 27,29,30-33, 34,36-39

© PARA Healt h Car e An alyt ics CPT® is a r egist er ed t r adem ar k of t h e Am er ican M edical Associat ion

PARA Weekly Update: March 21, 2018

TRAVEL ALLOWANCE

Question: What are the Medicare rules regarding reimbursement for travel when we send a lab tech to a nursing home to collect blood specimens?

Answer: The regulations pertaining to billing for travel reimbursement are found in Chapter 16 Laboratory Services of the Medicare Claims Processing Manual. Here is a link and an excerpt: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c16.pdf 60.2 - Travel Allowance (Rev. 3942; Issued: 12-22-17; Effective: 01- 01-18; Implementation: 01-22-18) In addition to a specimen collection fee allowed under ยง60.1, Medicare, under Part B, covers a specimen collection fee and travel allowance for a laboratory technician to draw a specimen from either a nursing home patient or homebound patient under ยง1833(h)(3) of the Act and payment is made based on the clinical laboratory fee schedule. The travel allowance is intended to cover the estimated travel costs of collecting a specimen and to reflect the technician?s salary and travel costs.

The additional allowance can be made only where a specimen collection fee is also payable, i.e., no travel allowance is made where the technician merely performs a messenger service to pick up a specimen drawn by a physician or nursing home personnel. The travel allowance may not be paid to a physician unless the trip to the home, or to the nursing home was solely for the purpose of drawing a specimen. Otherwise travel costs are considered to be associated with the other purposes of the trip.

The travel allowance is not distributed by CMS. Instead, the carrier must calculate the travel allowance for each claim using the following rules for the particular Code. The following HCPCS codes are used for travel allowances: Per Mile Travel Allowance (P9603) - The minimum ?per mile travel allowance? is $1.00. The per mile travel allowance is to be used in situations where the average trip to patients?homes is longer than 20 miles round trip, and is to be pro-rated in situations where specimens are drawn or picked up from non-Medicare patients in the same trip. - one way, in connection with medically necessary laboratory specimen collection drawn from homebound or nursing home bound patient; prorated miles actually traveled (carrier allowance on per mile basis); or - The per mile allowance was computed using the Federal mileage rate plus an additional 45 cents a mile to cover the technician?s time and travel costs. Contractors have the option of establishing a higher per mile rate in excess of the minimum ($1.00 a mile in CY 2018) if local conditions warrant it. The minimum mileage rate will be reviewed and updated in conjunction with the clinical lab fee schedule as needed. At no time will the laboratory be allowed to bill for more miles than are reasonable or for miles not actually traveled by the laboratory technician.

Example 1: In CY 2018, a laboratory technician travels 60 miles round trip from a lab in a city to a remote rural location, and back to the lab to draw a single Medicare patient?s blood. The total reimbursement would be $60.00 (60 miles x $1.00 a mile), plus the specimen collection fee.

Example 2: In CY 2018, a laboratory technician travels 40 miles from the lab to a Medicare patient?s home to draw blood, and then travels an additional 10 miles to a non-Medicare patient?s home and then travels 30 miles to return to the lab. The total miles traveled would be 80 miles. The claim submitted would be for one half of the miles traveled or $40.00 (40 x $1.00), plus the specimen collection fee.

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PARA Weekly Update: March 21, 2018

TRAVEL ALLOWANCE

Flat Rate (P9604) The CMS will pay a minimum of $10.00 (based on CY 2018) one way flat rate travel allowance. The flat rate travel allowance is to be used in areas where average trips are less than 20 miles round trip.The flat rate travel fee is to be pro-rated for more than one blood drawn at the same address, and for stops at the homes of Medicare and non-Medicare patients. The laboratory does the pro-ration when the claim is submitted based on the number of patients seen on that trip. The specimen collection fee will be paid for each patient encounter.

This rate is based on an assumption that a trip is an average of 15 minutes and up to 10 miles one way. It uses the Federal mileage rate and a laboratory technician?s time of $17.66 an hour, including overhead. Contractors have the option of establishing a flat rate in excess of the minimum of $10.00, if local conditions warrant it. The minimum national flat rate will be reviewed and updated in conjunction with the clinical laboratory fee schedule, as necessitated by adjustments in the Federal travel allowance and salaries.

The claimant identifies round trip travel by use of the LR modifier Example 3: A laboratory technician travels from the laboratory to a single Medicare patient?s home and returns to the laboratory without making any other stops. The flat rate would be calculated as follows: 2 x $10.00 for a total trip reimbursement of $20.00, plus the specimen collection fee.

Example 4: A laboratory technician travels from the laboratory to the homes of five patients to draw blood, four of the patients are Medicare patients and one is not. An additional flat rate would be charged to cover the 5 stops and the return trip to the lab (6 x $10.00 = $60.00). Each of the claims submitted would be for $12.00 ($60.00/5 = $12.00). Since one of the patients is non-Medicare, four claims would be submitted for $12.00 each, plus the specimen collection fee for each.

Example 5: A laboratory technician travels from a laboratory to a nursing home and draws blood from 5 patients and returns to the laboratory. Four of the patients are on Medicare and one is not.

The $10.00 flat rate is multiplied by two to cover the return trip to the laboratory (2 x $10.00 = $20.00) and then divided by five (1/5 of $20.00 = $4.00). Since one of the patients is non-Medicare, four claims would be submitted for $4.00 each, plus the specimen collection fee.

If a carrier determines that it results in equitable payment, the carrier may extend the former payment allowances for additional travel (such as to a distant rural nursing home) to all circumstances where travel is required. This might be appropriate, for example, if the carrier?s former payment allowance was on a per mile basis. Otherwise, it should establish an appropriate allowance and inform the suppliers in its service area. If a carrier decides to establish a new allowance, one method is to consider developing a travel allowance consisting of: - The current Federal mileage allowance for operating personal automobiles, plus a personnel allowance per mile to cover personnel costs based upon an estimate of average hourly wages and average driving speed - Carriers must prorate travel allowance amounts claimed by suppliers by the number of patients (including Medicare and non-Medicare patients) from whom specimens were drawn on a given trip - The carrier may determine that payment in addition to the routine travel allowance determined under this section is appropriate if: - The patient from whom the specimen must be collected is in a nursing home or is homebound; and the clinical laboratory tests are needed on an emergency basis outside the general business hours of the laboratory making the collection 3

PARA Weekly Update: March 21, 2018

HOME BASED TELEMONITORING

Question: I just got a request to create charges in the Living Center for Telemonitoring. Are you familiar with this service? What is the code used to report the services?

Answer: Telemonitoring (also known as RMT or Remote Monitoring Technologies)is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider.

In general, a patient will have a number of monitoring devices at home, and the results of these devices will be transmitted via telephone to the health care provider.

What are the benefits of offering these services in our Skilled Nursing Facility (SNF)? Interventions with a remote patient monitoring (RMT) have been shown in previous studies to be effective in the management of post-acute care and chronic disease management. The studies have shown in most cases, using RMT technologies can prevent emergency room visits and re-hospitalizations.

RMT technologies are designed to remotely - Collect, and - Track, and - Transmit Data that is related to the patient?s health from the patient care setting to a care provider or case care manager in a physically separate location. The technology shares real-time health information and education, as well as allowing for immediate feedback and adjustment to the patient regime.

Up until now most RMT technologies have been utilized in the post-acute care management of congestive heart failure. Real-time monitoring of biometric patient data has shown to prevent adverse health events, emergency room visits and re-hospitalizations.

RMT technologies can be used to track: -

Vital signs Behavioral health Location, Balance Gait

All patient health factors that are related to a resident?s chronic condition, post-acute care as well as safety and wellness. A principle form of RMT for safety and wellness uses sensors that are placed around an older adult residence. RMT technology offers SNF providers the ability to remotely monitor the resident effectively, yet they can also monitor the resident with sensor data use to determine potential preventable adverse effects on health from common nursing facility ailments such as: -

Falls Sleep disorders Poor response to medications Lack of repositioning Dehydration and UTIs

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PARA Weekly Update: March 21, 2018

HOME BASED TELEMONITORING

Challenges that have been encountered with utilizing RPM are in the area of reimbursement and the cost of the technology.

At this time, Medicare does reimburse for the usage of RMT.

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/ 2017-11-02.html

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PARA Weekly Update: March 21, 2018

HOME BASED TELEMONITORING

Wyoming Medicaid does not appear to reimburse for 99091 and S9110:

In conclusion to this article, if you should choose to invest in this technology what patients would benefit the most from this?

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Patients with cardiac, respiratory and/ or diabetic processes Patients with complex medical problems Patients with a known history of frequent hospitalizations Patients with the ability to learn how to correctly utilize the devices so they will be able to transmit the required data to the provider - Patients with poor compliance with physician-prescribed treatment plan (includes: self-reported measures, diet and/ or medications) - Patients living alone

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PARA Weekly Update: March 21, 2018

NURSING UNIT SUPPORT OF RADIOLOGY

Question: Surgery Care has always cared for the Radiology patients that have needed pre-and post-procedure care. Our volume has grown from a few (2-4) patients a month to 25-35/ month. These involve taking a nursing history, vitals, and starting an IV, in addition to the post-procedural care that can be anywhere from 1-6 hours after the procedure. Surgery Care does not charge anything to these patients. We typically have treated these Surgery Care services provided are ?bundled.?Should at least part of our nursing time be transferred to Radiology? Should we be able to charge something to the patient?

Answer: Nursing units which support the outpatient care process for surgical or interventional radiology cases frequently feel shorted because they have no means to recognize revenue for its contribution, mainly because the CPTÂŽ / HCPCS codes reported on an outpatient claim ?bundle? both surgical/ radiological services and all extended recovery services into the line item with the procedure HCPCS on the claim.

The problem is not primarily reimbursement, since Medicare and most Medicaid program reimbursement hinges on the HCPCS, not total charges (although payers with percent-of-charges reimbursement might pay more if there were higher charges.) The primary problem seems to be a budgeting issue ? the nursing department?s labor expense budgeting process may rely on heavily on revenue to justify FTE?s. Without revenue, the department struggles to justify FTE?s that are devoted to supporting a care process that offers no contribution to department revenue.

Here are several potential solutions for this sticky problem ? ultimately, it is the facility?s decision as to which path to take: 1. Track the contribution of the nursing department with a zero-charge statistical CDM line, and use this information to support the budgeting process for nursing labor expenses; 2. Transfer the labor expense from the nursing floor to the department that generated the revenue for the billable surgery/ radiology HCPCS ? for example, the nursing unit staff could charge the time spent in support of radiology patients to the radiology department G/ L; 3. Create a separate charge for the nursing department which is in the same revenue code as the primary surgical/ radiological procedure HCPCS. Bundle the nursing unit and surgical/ radiology charges together and report the total charges on the line reporting the surgical/ radiological HCPCS (see further discussion below); 4. Negotiate a specific value for the nursing support of each procedure and request that Accounting transfer a percentage of the revenue for the supported services to the appropriate nursing unit by G/ L adjustment on a regular basis; 5. Accept the issue as being more trouble to resolve than the reimbursement opportunity provided.

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PARA Weekly Update: March 21, 2018

NURSING UNIT SUPPORT OF RADIOLOGY

In regard to option 3, we suggest careful consideration before taking this path: -

Not every incidence of support from one department to the primary services of another department is worthy of an additional charge ? if we go down this path, the chargemaster will become cluttered with charges from departments that do not crosswalk to the nursing service revenue code on the Medicare Cost Report. An additional nursing unit charge should be permitted only if the same nursing service support is regularly and consistently rendered in support of another surgical/ radiological department care process. We recommend a fixed rate per case, rather than a variable amount per hour of nursing support.

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It is also important to consider the implications of option 3 on pricing. Hard-coded line items in the surgery or radiology department may have prices set as a function of Medicare reimbursement or other market factors; if the hard-coded procedure price will be inflated by additional charges from another department, it may undermine the accuracy and intent of prices established using reference data.

PLACE OF SERVICE RADIOLOGY READS

Question: What "Place Of Service" should be used if a Radiologist reads a test on campus for a clinic that is off campus? For example, our provider based clinic "Urgent Care" is off campus. The radiology test is done there but the Radiologist reads the test on our hospital based campus. Thanks Answer: Here is an excerpt from a Medicare FAQ document found at the link below: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/ Downloads/FAQs-CR7631-4-25-13.pdf F) What is the place of service (POS) for the professional component (PC) claim?

CMS Response: As a general policy, the POS for the PC of a diagnostic test (e.g. 71010 with modifier -26) shall be the setting in which the beneficiary received the technical component (TC) of the service. The POS code representing the setting where the beneficiary received the TC is entered in item 24B on the paper claim Form CMS 1500 (or its electronic equivalent).

Therefore, if the urgent care setting is an off-campus provider-based location, use POS 19 -- Off Campus-Outpatient Hospital. The definition of this POS code is: A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.

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PARA Weekly Update: March 21, 2018

HBIG B VACCINE

Question: What is the appropriate CPT® code(s) to report the HBIG Hepatitis B Vaccine?

Answer: Report HCPCS code J1571 or J1573, if the product administered is HepaGam. HCPCS code J1571 identifies injection, hepatitis B immune globulin (Hepagam B), when administered intramuscular.

HCPCS code J1573, identifies injection, hepatitis B immune globulin (Hepagam B), when administered intravenous.

An additional code for the method of administration of the Hepagam B (96372 or 96374) should be reported. Immune globulin contains antibodies against hepatitis B surface antigen and provides passive immunity to patients exposed to the HBV. Please refer to the PARA Data Editor code descriptions.

If other HBIG is administered, report CPT® 90371. CPT® code 90371 identifies the hepatitis B immune globulin (HBIg), passive immunization agent that gives protection against Hepatitis B and is obtained from donated, pooled human plasma. Report 90371 with G0010 for Medicare patients and 90471 for other payers. Please refer to the PARA Data Editor code description.

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PARA Weekly Update: March 21, 2018

MEDICARE BENEFICIARY FREQUENCY OF LEAVE, PART A SNF

Question: How often can a Medicare Beneficiary in a Part A covered Skilled Nursing Facility (SNF) stay leave the building? We have a patient currently that was admitted for IV antibiotics and daily wound care on his foot. Currently he is unable to put full weight on the foot according to the MD orders, yet he leaves our facility almost every day to go home following the administration of the antibiotic and wound care. He returns to the facility in time for dinner and stays overnight. Our Home Health Agency is only able to perform the care 2-3 times a week and there is no other facility in town that can provide the daily IV antibiotics and wound care to him. Are we ok to keep him here as a skilled inpatient?

Answer: The determination criteria for patients leaving the facility while they are in a Medicare Part A stay are described in the regulation in broad terms rather than specifics. From the perspective view of the MAC, the criteria applied is on a case-by-case review, with the expectation, the documentation will support the need for the skilled care in the facility. In a post-payment audit, MACs will challenge this case scenario questioning why the patient needs to be in the SNF if they can leave safely each day and return. For this reason, most facilities have policies and guidelines that help ensure patients remain in the facility during their Part A stay to avoid this challenge.

In addition, facilities must remember there is a liability to the facility during outings as long as the resident is still an inpatient The real question is if the beneficiary?s need for skilled care meets the ?practical matter? criteria outlined in the CMS Benefit Policy Manual, Chapter 8, Section 30.7. https:/ / www.cms.gov/ Regulations-and-Guidance/ Guidance/ Manuals/ Downloads/ bp102c08.pdf In addition, the manual further defines the practical matter criteria should never be interpreted by providers so strictly that it results in an automatic denial of coverage for the beneficiaries that have been meeting all of the SNF level of care requirements, but who have occasion to be away from the facility for a brief period of time.

Most beneficiaries that are admitted to a SNF facility under a Medicare Part A stay are unable to leave the facility. The fact that a patient is granted an outside pass or short leave of absence for the purpose of attending: 1.

2.

3.

4.

5.

A special religious service Holiday meal Family occasion Going for a car ride Trial visit at home This is not by itself evidence the beneficiary no longer requires to be in a SNF. Where there are frequent and prolonged periods away from the SNF, the MAC will question whether the patient?s care can, as a practical matter, only be

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PARA Weekly Update: March 21, 2018

MEDICARE BENEFICIARY FREQUENCY OF LEAVE, PART A SNF

This is not by itself evidence the beneficiary no longer requires to be in a SNF. Where there are frequent and prolonged periods away from the SNF, the MAC will question whether the patient?s care can, as a practical matter, only be furnished on an inpatient basis in a SNF. Decisions in these cases should be based on information reflecting the care needed and received by the patient while in the SNF and on the arrangements needed for the provision, if any, of this care during any absences.

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PARA Weekly Update: March 21, 2018

OPPS & HCPCS UPDATE APRIL 1 2018

Medicare has released the HCPCS update effective for dates of service on or after April 1, 2018.The changes pertain to reporting biosimilar infliximab. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM10454.pdf Effective for services as of April 1, 2018, The April 2018 HCPCS file includes these revised/new HCPCS codes: HCPCS Code: Q5101 - Short Description: Injection, zarxio - Long Description: Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram HCPCS Code: Q5103 - Short Description: Injection, inflectra - Long Description: Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg - Type of Service (TOS) Code: 1,P - Medicare Physician Fee Schedule Database (MPFSDB) Status Indicator: E HCPCS Code: Q5104 - Short Description: Injection, renflexis - Long Description: Injection, infliximab-abda, biosimilar, (renflexis), 10 mg - TOS Code: 1, P - MPFSDB Status Indicator: E HCPCS Code: Q2041 - Short Description: Axicabtagene ciloleucel car+ - Long Description: Axicabtagene Ciloleucel, up to 200 million autologous Anti-CD19 CAR T Cells, Including leukapheresis and dose preparation procedures, per infusion - TOS Code: 1 - MPFSDB Status Indicator: E Effective for claims with dates of service on or after April 1, 2018, HCPCS code Q5102 (which describes both currently available versions of infliximab biosimilars) will be replaced with two codes, Q5103 and Q5104. Thus, Q5102 Injection, infliximab, biosimilar, 10 mg, will be discontinued, effective March 31, 2018.

Also, beginning on April 1, 2018, modifiers that describe the manufacturer of a biosimilar product (for example, ZA, ZB and ZC) will no longer be required on Medicare claims for HCPCS codes for biosimilars. However, please note that HCPCS code Q5102 and the requirement to use biosimilar modifiers remain in effect for dates of service prior to April 1, 2018.

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PARA Weekly Update: March 21, 2018

OPPS & HCPCS UPDATE APRIL 1 2018

In other news, the OPPS Update for April 1 2018 was also published in the following MedLearn: https://www.cms.gov/Outreach-and-Education/ Medicare-Learning-Network-MLN/MLNMattersArticles/ downloads/MM10515.pdf

The update informs of the following changes: One New Separately Payable Procedure Code was added.

One skin substitute product was reassigned from the Low Cost Group to the High Cost Group.

Laboratory HCPCS: Effective January 1, 2018, Medicare has acknowledged one new Multianalyte Assays with Algorithmic Analyses (MAAA) code (0011M), eleven new PLA CPT® codes(specifically, CPT® codes 0024U through 0034U) and deleted two PLA codes (CPT® codes 0004U and 0015U). These updates were made too late in the year to be published in the January 1, 2018 OPPS Update.

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PARA Weekly Update: March 21, 2018

OPPS & HCPCS UPDATE APRIL 1 2018

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PARA Weekly Update: March 21, 2018

OPPS & HCPCS UPDATE APRIL 1 2018

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PARA Weekly Update: March 21, 2018

2018 CODING UPDATE NEW MODIFIER FY FOR COMPUTED RADIOGRAPHY Hospitals which use ?computed radiography? X-ray technology -- cassette-based imaging which utilizes an imaging plate to create the image involved ? must append modifier FY to HCPCS when billing Medicare for such services beginning on January 1, 2018. https://www.cms.gov/Regulations-and-Guidance/ Guidance/Transmittals/2017Downloads/R3820CP.pdf The FY modifier will result in a payment reduction of 7 percent of reimbursement on the technical component/ facility reimbursement for Computed Radiography services furnished during CY 2018, 2019, 2020, 2021, or 2022, that would otherwise be made under the Medicare Physician Fee Schedule or the hospital Outpatient Prospective Payment System (OPPS.)Similarly, if such X-ray services are furnished during CY 2023 or a subsequent year, the reduction in reimbursement will increase to 10 percent of the payment under the MPFS or the hospital OPPS. Radiologists reporting the professional component only (-26 modifier appended) need not report the FY modifier; the FY modifier is used to identify only the technical component of a radiography service to be discounted, thereby encouraging providers to upgrade to more modern equipment.

In the 2018 OPPS Final Rule, Medicare clearly outlines that the rules apply to hospitals which are paid under OPPS.Critical Access Hospitals are exempt from OPPS, and therefore the FY modifier will not be required for CAH claims. https://www.gpo.gov/fdsys/pkg/FR-2017-12-14/pdf/R1-2017-23932.pdf Federal Register / Vol. 82, No. 239 / Thursday, December 14, 2017 / Rules and Regulations, 59225 ?? We set forth the services that are excluded from payment under the OPPS in regulations at 42 CFR 419.22.Under ยง 419.20(b) of the regulations, we specify the types of hospitals that are excluded from payment under the OPPS. These excluded hospitals include: ? Critical access hospitals (CAHs);? ?

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PARA Weekly Update: March 21, 2018

BILLABLE SUPPLY LIST FOR CRITICAL ACCESS HOSPITALS Hospitals need to be cautious when billing for supplies, as Medicare considers some supplies routine and not separately billable; some supply items are covered, billable and payable; and others are covered and billable, but are packaged and not separately paid.

To determine when to separately bill for supplies, Medicare states the following criteria should be met: (Medicare Provider Reimbursement Manual, Section 2203.2) 1. Directly identifiable to a specific patient 2. Furnished at the direction of a physician because of specific medical needs (this must be documented in the patient's medical record 3. Either not reusable or representing a cost for each preparation Adminastar Federal, a Fiscal Intermediary, also created a checklist for providers to use when determining if a supply is billable or not.

Adminastar Federal used the Medicare Reimbursement Manual, Section 2203.2 as a guide in creating this checklist: 1. Is the item medically necessary and furnished at the discretion of a physician? (not a personal convenience item such as slippers, powder, lotion, etc.)

2. Is the item used specifically for or on the patient? (not gowns, gloves, masks, used by staff or oxygen available but not specifically used by the patient) 3. Is the item not ordinarily used for or on most patients or was the volume or quantity used for on patient significantly greater than normally used for or on most patients in the billed setting? (not blood pressure cuffs, thermometers, patient gowns, soap) 4. Is the item not basically stock (bulk) supply in the billed setting and the amount or volume used is typically measured or traceable to the individual patient for billing purposes? (not pads, drapes, cotton balls, urinals, bedpans, wipes, irrigation solutions, ice bags, IV tubing, pillows, towels, bed linen, diapers, soap, tourniquet, gauze, prep kits, oxygen masks, and oxygen supplies, syringes) There is not a CMS list of billable supply items, it is up to your facility to create a process to use in determining if a supply is billable or not. It is also important for the methodology to be used for all supply items, consideration of Managed Care Contracts supply billing requirement is also a requirement.

All implants should be separately billed; this would be revenue codes 0275, 0276, and 0278 Any Part B billable DME item should be separately billed, revenue code 0274 and HCPCS code LXXXX Any item which has an assignable HCPCS C code should be separately billed.

As with any item billable to Medicare, documentation and medical necessity must be substantiated in the patient?s medical record. If you have questions regarding billable supplies in your CDM, or to have your supply item CDM reviewed for compliance and coding, please do not hesitate to contact PARA for assistance.

Additional References: https://apps.para-hcfs.com/pde/documents/MedicareChargeableItemsList.pdf

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PARA Weekly Update: March 21, 2018

NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS

We have been working on making the PARA Data Editor compatible with multiple web browsers so that everyone can have options when it comes to which browser to use, depending on resources or preferences.

As of today, we are making available our PARA Data Editor Multiple Web Browser (Beta) Version to everyone with a proper PARA Data Editor Login.

The Web Browsers that we are rolling out first with this version are Internet Explorer and Google Chrome.

To all users who wish to use the Multiple Web Browser (Beta) Version, please be aware that this is a PRELIMINARY version meant to work out any errors and issues that it might exhibit.

It is in the process of being updated to mirror the current production version of the PARA Data Editor.

With your help, we will be able to narrow in on fixes throughout the PARA Data Editor Multiple Web Browser (Beta) Version to then ensure full functionality and to further expand to more Web Browsers.

The PARA Data Editor Multiple Web Browser (Beta) Version can be accessed via the following link and using the appropriate login when prompted by the browser: https://www.para-hcfs.com/projects/pde_upgrade/pde_MultBrowser

Note new interface with options.

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PARA Weekly Update: March 21, 2018

NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS

Once logged in, we would like for you to please be aware of a few key features to help us improve the PDE Multiple Browser (Beta) Version.

First, please be aware of the change in look for the Multiple Browser (Beta) Version. We are attempting to update the look and feel of the PDE to be cleaner and user-friendly.

Second, if you may have any questions, need help, would like to report an error or issue with the PDE Multiple Web Browser (Beta) Version, or anything else you may think of, click on the ?Contact Support? Link in the upper-right hand corner of the PDE:

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PARA Weekly Update: March 21, 2018

There were THREE new or revised Med Learn (MLN Matters) article released this week.

To go to the full Med Learn document simply click on the screen shot or the link.

FIND ALL THESE MED LEARNS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly Update: March 21, 2018

The link to this Med Learn: MM10445

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PARA Weekly Update: March 21, 2018

The link to this Med Learn: MM10527

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PARA Weekly Update: March 21, 2018

The link to this Med Learn: MM10512

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PARA Weekly Update: March 21, 2018

There were FIFTEEN new or revised Transmittals released this week.

To go to the full Transmittal document simply click

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly Update: March 21, 2018

The link to this Transmittal R2041OTN

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The link to this Transmittal R3999CP

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The link to this Transmittal: R2045OTN

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The link to this Transmittal: R2044OTN

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The link to this Transmittal: R2043OTN

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The link to this Transmittal: R2042OTN

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The link to this Transmittal: R778PI

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The link to this Transmittal: R18P232

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PARA Weekly Update: March 21, 2018

The link to this Transmittal: R4000CP

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The link to this Transmittal: R300FM

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PARA Weekly Update: March 21, 2018

The link to this Transmittal: R14P240

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The link to this Transmittal: R780PI

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The link to this Transmittal: R4001CP

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PARA Weekly Update: March 21, 2018

The link to this Transmittal: R242BP

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PARA Weekly Update: March 21, 2018

The link to this Transmittal: R114GI

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PARA Weekly Update: March 21, 2018

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